GASTROENTEROLOGY ARTICLE OF THE WEEK

FEBRUARY 24, 2000

 Brugge WR, Van Dam J.  Pancreatic and Biliary Endoscopy.  N Engl J Med 1999;341:1808-1816.

1.  Endoscopic management of biliary leaks

a.      always requires a sphincterotomy

b.      is effective because it eliminates the resistance to flow created by the Sphincter of Oddi

c.      Placement of a temporary stent appears to be more effective than performing sphincterotomy only

d.      Many cases of biliary leaks treated by ERCP will eventually require surgery for definitive repair.

 True or False

 2.  Pancreatitis or small retroperitoneal perforations occur in 5% to 10% of patients undergoing therapeutic ERCP.

 3.  The use of pancreatic stents can result in changes consistent with chronic pancreatitis.

 4.  In a patient with cholangitis, septicemia and hypotension secondary to biliary obstruction from a CBD stone, the treatment of choice is ERCP with sphincterotomy and stone removal.

 5.  Plastic biliary stents require replacement every one to three months due to the formation of a biofilm, a layer of bacteria and mucin.  Metal stents, in contrast, can maintain patency for an average of 9 months.

 6.  Surgery for patients with cholangitis is associated with a lower rate of complications compared to ERCP with drainage.

 7.  Pancreatic duct stenting for the treatment of chronic pancreatitis with pancreatic duct strictures has proven to be an effective method of long-term palliation.

 8.  Jaundice, whether or not associated with cholangitis, indicates the need for emergent ERCP in patients with suspected CBD stones.

 9.  Endoscopic ultrasound of the pancreas has a 60% to 70% sensitivity for the detection of pancreatic gastrinomas and insulinomas.

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